Kidneys
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Role of ultrasoundThe mid to distal ureter is generally obscured by bowel gas. Small lesions at the upper pole of the kidney may be difficult to see due to refractive edge shadowing. This can be overcome with thorough scanning technique. Equipment selectionHighest frequency curved linear array probe possible. Start with 7MHz and work down to 2 or 3 for larger patients. Assess the depth of penetration required and adapt. Paediatric and thin pts should be scanned with a 7MHz. Good colour / power / Doppler capabilities when assessing vessels or vascularity of a structure.Patient PositionBegin with the patient supine. Each kidney will need to be examined in the decubitus position. Raise the ipsilateral arm above the patient's head.Technique
A comprehensive, targeted examination of the renal tracts should always include assessment of theurinary bladderand, in males,the prostate.
Scan longitudinally subcostally. Visualise the kidney inferior to the right lobe of the liver (RT kidney), or spleen (LT kidney).Place the probe between iliac crest and the lower costal margin to examine in the coronal plane. Ensure the kidney is thoroughly examined from edge to edge.Rotate into transverse. Scan from beyond the superior margin to inferior.Document the normal anatomy and any pathology found, including measurements and vascularity if indicated.What to check:
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- To identify the cause of:
- Flank pain
- Haematuria (frank or microscopic)
- Follow-up of previously identified pathology
- Classification of a mass (Solid V's cystic)
- Post surgical complications
- Guidance of aspiration, biopsy or intervention
- Post injury
A comprehensive, targeted examination of the renal tracts should always include assessment of theurinary bladderand, in males,the prostate.
Scan longitudinally subcostally. Visualise the kidney inferior to the right lobe of the liver (RT kidney), or spleen (LT kidney).Place the probe between iliac crest and the lower costal margin to examine in the coronal plane. Ensure the kidney is thoroughly examined from edge to edge.Rotate into transverse. Scan from beyond the superior margin to inferior.Document the normal anatomy and any pathology found, including measurements and vascularity if indicated.What to check:
- Kidney size (should not be >1cm difference between sides)
- Cortical thickness(not <10mm)
- Cortico-medullary differentiation
- Cortex at least as hypoechoic as the liver
- Pyramids slightly hypoechoic relative to the cortex
- No hydronephrosis
- Renal scarring(beware mistaking prominant lobulations as scars)
- Unilateral renal agenesis
- Atrophic small kidney
- Horseshoe kidney
- Ectopic kidney
- Duplex kidney
- Cross fused ectopia
- Renal cyst
- Cortical
- Parapelvic
- Calculus
- Hydronephrosis
- Angiomyolipoma
- Renal cell carcinoma
- Transitional cell carcinoma
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